Editorial: A moral and financial argument to expand Medicaid

Rep. Neal Kurk of Weare, a force in the Legislature who leads by the power of his arguments, cut to the chase in the debate over whether New Hampshire should join the 23 states that have agreed to expand Medicaid. Expanding Medicaid, in short, means accepting federal money under the 2010 Affordable Care Act to do what New Hampshire has never done: offer coverage to all adults up to 138 percent of the federal poverty level.

Speaking last week on New Hampshire Public Radio’s The Exchange, Kurk said that the people of New Hampshire are of two opinions about doing so. One “believes the state has an obligation to care for poor people and provide them with all sorts of entitlements. . . . There is another group that feels that it’s not the role of government to provide services to everyone. Simply because you are poor is not a reason for you to be entitled, in this case, to health care. The idea is almost an immoral kind of decision. . . . This is a country that believes in personal responsibility. Unless there is something . . . wrong with you, your obligation is to work your way up into the system, ” Kurk said.

Leave aside, for now, the fact that many people, and more than a few nations, believe that human beings have a moral right to health care. That right, in the United States, is recognized in a limited way by laws that require hospitals to provide emergency care to all, whether they can pay for it or not.

Forget for the moment that Kurk’s Horatio Alger belief that anyone who isn’t in some way disabled can and should work hard and improve their lot enough to afford health insurance is unfounded. That view reflects a profound misunderstanding of the realities, economic and otherwise, faced by the middle class, let alone the poor. The days when most jobs came with good quality, affordable health insurance coverage are over.

Kurk sits on a nine-member commission charged with issuing by Oct. 15 a recommendation on whether the state should or should not expand Medicaid and, if it does, with what if any qualifications. In a more straightforward way than any other member, Kurk questions whether it’s the government’s role to provide health insurance for those who can’t afford it. Questions of morality aside, we believe the answer is yes, because doing so benefits all of us.

Children who fail to learn because they are hungry, ill or in pain from a lack of dental care are more likely to become dependent on society for help. Feed them, heal them and provide preventive health care, and they are far more likely to succeed and repay society by paying more in taxes.

The same is true for many adults who, though they work, do not earn enough to buy ever more costly health insurance.

The economic argument for expanding Medicaid is strong. What the uninsured poor don’t get is regular preventive health care that keeps them at work and out of hospitals. Instead, they get expensive treatment in emergency rooms and enormously expensive hospital stays for chronic conditions that were allowed to deteriorate.

The cost of that care is shifted to employers and the insured in the form of higher health care premiums and state subsidies to hospitals.

Providing health coverage increases low-income citizens’ ability to exercise personal responsibility by doing more of what it takes to stay healthy and on the job instead of in a hospital or on disability payments. It allows them to contribute to the local economy rather than be a drain on it. It lowers the cost of health care for all, which is why those on the commission who don’t believe that the poor have a moral right to health care should nonetheless vote to expand Medicaid.

The Congressional Budget Office last week released updated historical budget data for the federal government, reporting a deficit of $1.087 trillion in fiscal 2012. 2012 marked the fourth straight year—and the only four years in the history of the nation--when the federal government’s deficit topped $1 trillion. Last year’s $1.087 trillion deficit was even greater in inflation-adjusted dollars than the peak World War II deficit of fiscal 1943—which was $54.554 billion in 1943 dollars and $723.8714 billion in 2012 dollars, according to the Bureau of Labor Statistics online inflation calculator.

gracchus wrote:

08/19/2013

For the umpteenth time Neal Kurk demonstrates his adherence to the "I'm All Right, Jack" philosophy of public policy.

BestPresidentReagan wrote:

08/18/2013

Expanding Medicaid is suicide...."For 100 years, the socialist we call "liberals" and "progressives" have systematically destroyed the Constitutional Republic with progressive taxes, fractional reserve and fiat money policies, crony capitalism and created a bureaucratic Leviathan. To be clear, it was not conservatives and libertarians that undermined and discarded Constitutional standards. Today we are faced with $17 trillion in contracted debt obligations and perhaps $100T in unfunded liabilities. The Fed has increased their Balance Sheet from some $900B to over $3T in five years while increasing the Money Supply from $3T to $9T with $85B increase per month. The economy is in cardiac arrest and the patient is dying."

gracchus wrote:

08/19/2013

The tab says, "Reply to this comment." The only possible reply is to point out that the numbers sail cites, all take out of context, show how willing one can be to be frightened by what one doesn't understand.

BestPresidentReagan wrote:

08/19/2013

100% Facts that democrats simply hate to see

gracchus wrote:

08/19/2013

Not facts, factoids; and meaningless out of context.

TCB wrote:

08/18/2013

Do I hear you saying that because some other countries have national healthcare that is automatically the right thing for us to do? Some other countries have a stated position that the cruelest form of Shirai law is the right thing to do-does that make them right? It’s always easy to spend someone else’s money isn’t? The logic is inescapable- increasing services (of any kind) to people who do not pay for it- means someone else has to be taxed more-a great deal more! Who’s the bunny? Who’s going to get the taxation whack? Do you really think that this comes for free? Standard social Leftist position-promise other people more services, more benefits, more largess that they don’t have to pay for. Paraphrased, we’ve heard over and over, “you get this for free-don’t worry, someone else will be paying for this” So be honest; who will be taxed to the point where they cannot put away for retirement? Who will be taxed to the point where they cannot open a new business and are forced into low-level employment for life? All national healthcare services have one thing in common-they are two-tiered. That is, there’s a basic care provided by the national healthcare service designed to keep working people healthy enough to paying taxes & working. In the greatest majority of these examples nonworking older people are not eligible for more sophisticated medical care. Are you going to be honest about that and telling grandma might have to wait three years, if ever, you new hip? I recently talked to a pain physician from Canada who stated it takes three years for patient to get into his clinic. I responded, “surely you mean three months?”. He stated, “no I meant three years!” Are you going to be honest and tell all these people you are trying to turn into Democratic voters, with this, “everything for free” appeal, the truth? There will be basic level care possibly and of course people with means will always be able to get world-class care anytime they want. Are you ready to speak that reality or you going to hide that for another day?

Field-of-Ferns wrote:

08/19/2013

Of course it's not free - it's already paid for by the federal taxes we in NH send in, and will continue to send in whether we accept the grant or not. If we don't accept it, OUR federal tax money will go to another state. That's plain and simple. (2) Expanded Medicaid is not National Healthcare. Stop putting words in other people's mouths. The writer is not asking for it. Expanding Medicaid will not take services away from nonworking older people. (3) The working poor will be required to take personal responsibility and get health insurance, or face a fine. They will not be eligible for the exchanges and will get no assistance to pay for it. So, they will have no insurance, and they'll have to pay a fine. Talk about kicking someone while they're down.